Library

Knowledge is power. In healthcare, that phrase is especially true. That's why we've put together some information of the most common, and not so common, problems our patients face. We invite you to browse our library and become a better informed, more knowledgeable patient.

Attention deficit hyperactivity disorder (ADHD) is a developmental disorder characterized primarily by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone".

Cerebral palsy (CP) is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement.

Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced

Premenstrual syndrome (PMS) is a collection of physical and emotional symptoms related to a woman's menstrual cycle. Medical definitions of PMS are limited to a consistent pattern of emotional and physical symptoms.

Spinal stenosis is an abnormal narrowing (stenosis) of the spinal canal that may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal cord, resulting in a neurological deficit.

With 3,480 pages of fine print, the Physicians' Desk Reference (a.k.a. PDR) is not a quick read. That's because it contains every iota of information on more than 4,000 prescription medications. Heck, the PDR is medication — a humongous sleeping pill.

Doctors count on this compendium to help them make smart prescribing decisions — in other words, to choose drugs that will solve their patients' medical problems without creating new ones. Unfortunately, it seems some doctors rarely pull the PDR off the shelf. Or if they do crack it open, they don't stay versed on emerging research that may suddenly make a once-trusted treatment one to avoid. Worst case: You swallow something that has no business being inside your body.

Of course, plenty of M.D.'s do know which prescription and over-the-counter drugs are duds, dangers, or both. So we asked them, "Which medications would you skip?" Their list is your second opinion. If you're on any of these meds, talk to your doctor. Maybe he or she will finally open that big red book with all the dust on it.

Advair

It's asthma medicine ... that could make your asthma deadly. Advair contains the long-acting beta-agonist (LABA) salmeterol. A 2006 analysis of 19 trials, published in the Annals of Internal Medicine, found that regular use of LABAs can increase the severity of an asthma attack. Because salmeterol is more widely prescribed than other LABAs, the danger is greater — the researchers estimate that salmeterol may contribute to as many as 5,000 asthma-related deaths in the United States each year. In 2006, similarly disturbing findings from an earlier salmeterol study prompted the FDA to tag Advair with a "black box" warning — the agency's highest caution level.

Your new strategy: No matter what you may have heard, a LABA, such as the one in Advair, is not the only option, says Philip Rodgers, Pharm.D., a clinical associate professor at the University of North Carolina school of pharmacy. For instance, if you have mild asthma, an inhaled corticosteroid such as Flovent is often all you need. Still wheezing? "Patients can also consider an inhaled corticosteroid paired with a leukotriene modifier," says Dr. Rodgers. This combo won't create dangerous inflammation, and according to a Scottish review, it's as effective as a corticosteroid-and-LABA combo.

Avandia

Diabetes is destructive enough on its own, but if you try to control it with rosiglitazone — better known by the brand name Avandia — you could be headed for a heart attack. Last September, a Journal of the American Medical Association (JAMA) study found that people who took rosiglitazone for at least a year increased their risk of heart failure or a heart attack by 109 percent and 42 percent, respectively, compared with those who took other oral diabetes medications or a placebo.

The reason? While there have been some reports that Avandia use may cause dangerous fluid retention or raise artery-clogging LDL cholesterol, no one is sure if these are the culprits. That's because the results of similar large studies have been mixed. So the FDA has asked GlaxoSmithKline, the maker of Avandia, to conduct a new long-term study assessing users' heart risks. There's only one problem: The study isn't expected to start until later this year.

Your new strategy: Stick with a proven performer. "I prefer metformin, an older, cheaper, more dependable medication," says Sonal Singh, M.D., the lead author of the JAMA study. "Avandia is now a last resort." Dr. Singh recommends that you talk to your doctor about cholesterol-lowering medicines, such as statins or the B vitamin niacin. Swallowing high doses (1,000 milligrams) of niacin daily may raise your HDL (good) cholesterol by as much as 24 percent, while at the same time lowering your LDL and triglyceride levels.

Celebrex

Once nicknamed "super aspirin," Celebrex is now better known for its side effects than for its pain-relieving prowess. The drug has been linked to increased risks of stomach bleeding, kidney trouble, and liver damage. But according to a 2005 New England Journal of Medicine study, the biggest threat is to your heart: People taking 200 mg of Celebrex twice a day more than doubled their risk of dying of cardiovascular disease. Those on 400 mg twice a day more than tripled their risk, compared with people taking a placebo.

And yet Celebrex, a COX-2 inhibitor, is still available, even though two other drugs of that class, Bextra and Vioxx, were pulled off the market due to a similar risk of heart damage. The caveat to the consumer? In 2004, the FDA advised doctors to consider alternatives to Celebrex.

Your new strategy: What you don't want to do is stop swallowing Celebrex and begin knocking back ibuprofen, because regular use of high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to gastrointestinal bleeding. A safer swap is acupuncture. A German study found that for people suffering from chronic lower-back pain, twice-weekly acupuncture sessions were twice as effective as conventional treatments with drugs, physical therapy, and exercise. The strategic needling may stimulate central-nervous-system pathways to release the body's own painkillers, including endorphins and enkephalins, says Duke University anesthesiologist Tong-Joo Gan, M.D. You can find a certified acupuncturist in your area at medicalacupuncture.org/findadoc/index.html.

Ketek

Most bacteria in the lungs and sinuses don't stand a chance against Ketek, but you might not either. This antibiotic, which has traditionally been prescribed for respiratory-tract infections, carries a higher risk of severe liver side effects than similar antibiotics do. "Ketek can cause heart-rhythm problems, can lead to liver disease, and could interact poorly with other medications you may be taking," says Dr. Rodgers. "Unfortunately, it's still available, and although many doctors are aware of the risks, some may still prescribe it without caution." In February 2007, the FDA limited the usage of Ketek to the treatment of pneumonia.

Your new strategy: Can't imagine catching pneumonia? The last time the Centers for Disease Control and Prevention calculated the top 10 killers of men, this deadly lung infection (along with the flu) came in seventh. Avoid backing yourself into a corner where you might need Ketek by always signing up for your annual flu shot — if you have pneumonia, it'll reduce your risk of dying of the infection by 40 percent. And if you still end up staring at a scrip for Ketek, Dr. Rodgers recommends asking to be treated with one of several safer alternatives, such as Augmentin or the antibiotics doxycycline or Zithromax.

Prilosec and Nexium

Heartburn can be uncomfortable, but heart attacks can be fatal, which is why the FDA has investigated a suspected link between cardiac trouble and the acid-reflux remedies Prilosec and Nexium. In December 2007, the agency concluded that there was no "likely" connection. Translation: The scientific jury is still out. In the meantime, there are other reasons to be concerned. Because Prilosec and Nexium are proton-pump inhibitors, they are both incredibly effective at stopping acid production in the stomach — perhaps too effective.

A lack of acid may raise your risk of pneumonia, because the same stuff that makes your chest feel as if it's burning also kills incoming bacteria and viruses. You may also have an elevated risk of bone loss — in the less acidic environment, certain forms of calcium may not be absorbed effectively during digestion. "The risk of a fracture has been estimated to be over 40 percent higher in patients who use these drugs long-term, and the risk clearly increases with duration of therapy," says Dr. Rodgers.

Your new strategy: When you feel the fire, first try to extinguish it with Zantac 150 or Pepcid AC. Both of these OTC products work by blocking histamine from stimulating the stomach cells that produce acid. Just know that neither drug is a long-term fix.

"To really cure the problem, lose weight," says Michael Roizen, M.D., chief wellness officer at the Cleveland Clinic and co-author of "YOU: The Owner's Manual." That's because when you're overweight, excess belly fat puts pressure on and changes the angle of your esophagus, pulling open the valve that's supposed to prevent stomach-acid leaks. This in turn makes it easier for that burning sensation to travel up into your chest.

Visine Original

What possible harm to your peepers could come from these seemingly innocuous eyedrops? "Visine gets the red out, but it does so by shrinking blood vessels, just like Afrin shrinks the vessels in your nose," says Thomas Steinemann, M.D., a spokesman for the American Academy of Ophthalmology. Overuse of the active ingredient tetrahydrozoline can perpetuate the vessel dilating-and-constricting cycle and may cause even more redness.

Your new strategy: If you still want to rely on Visine, at least make sure you don't use too many drops per dose and you don't use the stuff for more than 3 or 4 days. But you'd really be better off figuring out the underlying cause of the redness and treating that instead. If it's dryness, use preservative-free artificial tears, recommends Dr. Steinemann. Visine Pure Tears Portables is a good choice for moisture minus side effects. On the other hand, if your eyes are itchy and red because of allergies, pick up OTC antiallergy drops, such as Zaditor. It contains an antihistamine to interrupt the allergic response but no vasoconstrictor to cause rebound redness.

Pseudoephedrine

Forget that this decongestant can be turned into methamphetamine. People with heart disease or hypertension should watch out for any legitimate drug that contains pseudoephedrine. See, pseudoephedrine doesn't just constrict the blood vessels in your nose and sinuses; it can also raise blood pressure and heart rate, setting the stage for vascular catastrophe. Over the years, pseudoephedrine has been linked to heart attacks and strokes. "Pseudoephedrine can also worsen symptoms of benign prostate disease and glaucoma," says Dr. Rodgers.

Your new strategy: Other OTC oral nasal decongestants can contain phenylephrine, which has a safety profile similar to pseudoephedrine's. A 2007 review didn't find enough evidence that phenylephrine was effective. Our advice: Avoid meds altogether and clear your nasal passages with a neti pot, the strangely named system that allows you to flush your sinuses with saline ($15, sinucleanse.com). University of Wisconsin researchers found that people who used a neti pot felt their congestion and head pain improve by as much as 57 percent. Granted, the flushing sensation is odd at first, but give it a chance. Dr. Roizen did: "I do it every day after I brush my teeth," he says.

A case study published in the July 2006 issue of the peer-reviewed, scientific publication, the Journal of Clinical Chiropractic Pediatrics (JCCP) documented the effects of chiropractic care on a nine month old infant girl with a history of disturbed sleep. The JCCP is the official publication of the Council on Chiropractic Pediatrics of the International Chiropractors Association.

The study article starts off by noting that the average 9 month old should sleep approximately 14 hours per day. In this case study a nine month old infant girl was presented for chiropractic care with a history of severely disrupted sleep and fussiness. Additionally, the infant was refusing to breastfeed on one side and exhibited, what was called a generally unsettled behavior. It was also noted that the child would not turn her head to the left. These problems had been occurring since birth."

The examination confirmed a reduced range of neck motion to the left and significant muscle tension in the left and upper neck. Upon touching the neck the child exhibited signs of being in pain by crying and moving away. It was determined that subluxations were present, and an appropriate course of adjustments was initiated."

The results in this case were very impressive. The study noted that on the afternoon after the infants first adjustment the baby girl fell asleep for 5 hours. This was followed by nighttime sleep of 2 periods of 6 hours each. Over the next three weeks of care the daytime sleep got shorter, but the nighttime sleep remained between 6 and 8 hours."

In addition to the dramatic sleep improvement, the child also improved her range of neck motion and was able to turn her head to the left in response to sound on the left side. Additionally the infant began to feed freely and comfortably."

In their conclusion, the authors of the case study noted that the dramatic improvements after just one adjustment indicated that the vertebral subluxation found in this case was at least in part responsible for the disrupted sleep pattern."

In the October 2004 issue of the peer-reviewed research publication, the Journal of Manipulative and Physiological Therapeutics (JMPT), comes a case study of a child with ADHD (Attention-Deficit/Hyperactivity Disorder), who was helped with chiropractic.

The case was of a 5 year old boy who had been diagnosed with ADHD at age 2. The child's pediatrician prescribed methylphenidate (Ritalin), Adderall, and Haldol for the next 3 years. The combination of drugs was unsuccessful in helping the child. At age 5 the child was brought to a chiropractor to see if chiropractic care would help. The history taken at that time noted that during the child's birth, there were complications during his delivery process. The results of this trauma and complications resulted in a 4-day stay in the neonatal intensive care unit. The child's mother reported no other incidence of trauma.

The chiropractic examination and x-rays showed noticeable spinal distortion including a reversal of the normal neck curve indicative of subluxations. Chiropractic care was begun and the child's progress was monitored.

According to his mother, positive changes in her son's general behavior were noticed around the twelfth visit. By the 27th visit the patient had experienced considerable improvement.

The child was brought by the mother to the medical doctor for a follow up visit and questioned the usage of the Ritalin. The medical doctor reviewed and examined the child and based on that assessment and his clinical experience, the MD felt that the young boy was no longer exhibiting symptoms associated with ADHD. He then took the boy off the medications that he had been taking for 3 years.

The conclusion of the author of the JMPT case study noted, "The patient experienced significant reduction in symptoms. Additionally, the medical doctor concluded that the reduction in symptoms was significant enough to discontinue the medication."

In the October 2004 issue of the peer-reviewed research publication, the Journal of Manipulative and Physiological Therapeutics (JMPT), comes a case study of a child with ADHD (Attention-Deficit/Hyperactivity Disorder), who was helped with chiropractic.

The case was of a 5 year old boy who had been diagnosed with ADHD at age 2. The child's pediatrician prescribed methylphenidate (Ritalin), Adderall, and Haldol for the next 3 years. The combination of drugs was unsuccessful in helping the child. At age 5 the child was brought to a chiropractor to see if chiropractic care would help. The history taken at that time noted that during the child's birth, there were complications during his delivery process. The results of this trauma and complications resulted in a 4-day stay in the neonatal intensive care unit. The child's mother reported no other incidence of trauma.

The chiropractic examination and x-rays showed noticeable spinal distortion including a reversal of the normal neck curve indicative of subluxations. Chiropractic care was begun and the child's progress was monitored.

According to his mother, positive changes in her son's general behavior were noticed around the twelfth visit. By the 27th visit the patient had experienced considerable improvement.

The child was brought by the mother to the medical doctor for a follow up visit and questioned the usage of the Ritalin. The medical doctor reviewed and examined the child and based on that assessment and his clinical experience, the MD felt that the young boy was no longer exhibiting symptoms associated with ADHD. He then took the boy off the medications that he had been taking for 3 years.

The conclusion of the author of the JMPT case study noted, "The patient experienced significant reduction in symptoms. Additionally, the medical doctor concluded that the reduction in symptoms was significant enough to discontinue the medication."

Much discussion goes on in health care circles as to what to call what chiropractors do. Is the term manipulation or adjustment? To answer this question lets first look in a Webster Dictionary for some synonyms of each.Manipulation: Exploit, misuse, take advantage, control, deploy, maneuver, use, ply, swing, wield, grope, examine, finger, fondle, handle, maul, palpate, paw, probe, touch, govern, sway.

The International Chiropractors Association has a policy on this subject that says it best; The ICA holds that the chiropractic spinal adjustment is unique and singular to the chiropractic profession. The chiropractic adjustment shall be defined as a specific directional thrust that sets a vertebra into motion with the intent to improve or correct vertebral malposition or to improve its juxtaposition segmentally in relationship to its articular mates thus reducing or correcting the neuroforaminal / neural canal encroachment factors inherent in the chiropractic vertebral subluxation complex. The adjustment is characterized by a specific thrust applied to the vertebra utilizing parts of the vertebra and contiguous structures as levers to directionally correct articular malposition. Adjustment shall be differentiated from spinal manipulation in that the adjustment can only be applied to a vertebral malposition with the express intent to improve or correct the subluxation, whereas any joint, subluxated or not, may be manipulated to mobilize the joint or to put the joint through its range of motion. Chiropractic is a specialized field in the healing arts, and by prior rights, the spinal adjustment is distinct and singular to the chiropractic profession.

The above headline comes from the United Kingdom on March 11, 2013 from The Telegraph. The article starts off by quoting Professor Dame Sally Davies, the UK Chief Medical Officer (CMO) who said that the threat posed by antibiotic resistance is a "ticking time-bomb", which should be put on the UK's National Risk Register.

Professor Davies's comments were based on her report published on March 11, 2013 titled, "Annual Report of the Chief Medical Officer". Highlighting the importance Professor Davies gives to this issue, the subtitle of her report reads, "Infections and the rise of antimicrobial resistance."

According to the Telegraph article, "The problem is a “ticking time bomb” and should be put on the National Risk Register — which also includes “catastrophic terrorist attacks” and other civil emergencies, Prof Dame Sally Davies said.

Another article on the same subject in The Guardian on March 17, 2013 points out how serious this issue is by saying, "Antibiotic-resistant bacteria kill far more people each year globally than terrorism." The Guardian further illustrates their point by reporting that the, "World Health Organization estimates that for tuberculosis alone multi-drug resistance accounts for more than 150,000 deaths each year."

A number of the articles addressing this issue point out that the main reason for the rise in antibiotic resistance is the overuse and indiscriminant use of antibiotics. One article notes that in years to come, if this problem is not kept in check, almost half of the people who have surgery, such as hip replacement, will succumb to an infection, and of those about 30% will die from it.

In an April 9, 2013 news article on the UK government website Professor Anthony Kessel, Director of Public Health Strategy at PHE, sums up the issue by saying: "We are very pleased that the CMO is giving the issue of antibiotic resistance her full attention. This is not a clinical issue but one that affects all of us and we must change our attitude towards antibiotics. They certainly have their place for treating bacterial infections but too often are given for viral illnesses which contribute towards the problems we are facing today. This will require more awareness raising and education both for clinicians and the public on how we use the antibiotics that we have."

The Annals of Internal Medicine published the results of a survey of 232 people who had arthritis and were under a rheumatologists care. Of those 63% responded to the survey by saying they were using some form of "complementary care" as named by the study.Â Of those people 31% were using chiropractic. These number may themselves be grossly under reported as only 45% of the patients told their doctor about using the other forms of care.

These reported numbers translate to over 19% of the public who is seeing a rheumatologists is also seeing a chiropractor. And if less that half of the patients are telling their doctor about it the actual number may be twice as high.

Possibly the most impressive statistic was that 73% of those trying chiropractic found it helpful. The reasons given why people said they tried the non-medical care was to control pain, because they heard it helps, because it is safe, because it helped someone they know, and because their prescription medication wasn't working.

Asthma has become a large health concern for children in recent years. Over the past 20 years the incidence of asthma has doubled. The Centers for Disease Control and Prevention (CDC) estimated that in 1998, approximately 17,299,000 people in the United States, or 6.4% of the population, with cases among very young children up 160%. As reported in the June 16, 1999 issue of JAMA, the CDC also noted that between 1980 and 1994, the number of people self-reporting asthma grew 75%.

In a study conducted in 1996 by the Michigan Chiropractic Council (MCC), a panel of doctors performed an out-come assessment study to test the qualitative and quantitative effectiveness of chiropractic care on children with asthma. The high demand of parents seeking alternative care for pediatric asthma was shown by the overwhelming interest in the study.Â More than 500 parents called the MCC seeking to get their child involved in the chiropractic study.

The study, which took place during May and June of 1996, examined the chiropractic effectiveness in correcting the cause of asthma in patients from birth to age 17. The average age of the participant was 10 years. "After 30 days of chiropractic health care, patients averaged only one attack, whereas prior to the study they were experiencing more than four attacks," said MCC Dr. Bob Graham, who directed the study. "Medications, which can be costly, were decreased by nearly 70 percent. Finally, patient satisfaction was rated 8.5 on a scale of 10." More than 70 chiropractors from 62 cities in Michigan studied more than 80 children suffering from asthma.

From the November / December 2000 issue of Todays Chiropractic, comes a study report on Asthma. The article notes that approximately 14 Americans die each day from asthma. Asthma is only one of three diseases that has shown an increasing death rate in recent years, up 58% since 1979.Â Presently estimates say that 17 million Americans suffer from the disease making it the most common and costly illness in the United States today, costing over $13 billion annually. Presently, asthma causes more hospitalizations of children than any other childhood disease.

In the study, 47 patients were observed for a two year period. These patients had all been medically diagnosed with persistent asthma ranging from mild persistent in 11 cases, moderate persistent in 28 cases, to severe persistent in 8 cases. The care rendered consisted of specific chiropractic adjustments. The range of visits was from 14 to 44, with the average being 26 during the study period. Most patients in the study began care at a rate of 3 visits per week with this frequency being reduced after 4 to 8 initial weeks.

The patient results were very good with all 47 of the study patients showing a marked improvement ranging from 87 to 100 percent. Patient observed improvement was measured by both improvement in their symptoms as well as a decrease in their usage of acute asthma attack medication. Even more impressive was that all of the patients in the study reported maintaining their improvement after a two-year follow up.

Poorly fitting athletic shoes can hurt your stride and therefore your spine. This information was reported in a Dec. 6, 2005 release appearing on PRNewswire. According to the American Chiropractic Association (ACA), footwear plays an important role in the functional biomechanics of the human body.

The article also reports that improperly-fitting shoes can do more than hurt a runner's stride, they can upset a person's overall biomechanics and lead to pain throughout the body.Â Dr. Jeffery Solomon, president of the ACA's Council on Sports Injuries & Physical Fitness noted, "Your feet are the foundation of your body, and if they are not properly supported you can have problems anywhere from the bottom of your feet up through your neck."

The article posted several tips to consider before a runner should purchase their next pair of running shoes. These are:

- Be sure to match the right shoe to the right activity. If possible, purchase running shoes from a specialty store or from someone knowledgeable about matching the correct type of running shoes to your foot type and stride pattern.

- Select shoes with adequate cushioning in the soles, which helps absorb the shock of your feet hitting the ground. Cushioning is especially important when running on hard surfaces, such as pavement or sidewalks.

- Check for adequate room at the widest part of your foot. The shoe shouldn't be tight, but your foot shouldn't slide around, either.

- Consider custom made orthotic insoles. Orthotics can address structural abnormalities in the feet and the resultant biomechanical faults.